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Difficulty: MediumPharmacological Therapies

A client is receiving treatment for a deep vein thrombosis and is transitioning to oral warfarin therapy. The practical nurse (PN) reviews the morning laboratory results and notes that the client's International Normalized Ratio (INR) is 4.54.5. The client's next scheduled dose of oral warfarin is due in 30 minutes30\text{ minutes}. Which of the following actions should the PN take?

  1. Withhold the scheduled dose of warfarin and immediately notify the registered nurse (RN).Answer
  2. B
    Administer the scheduled dose of warfarin because the INR is within the expected therapeutic range for this condition.
  3. C
    Reduce the warfarin dose by half and administer it to prevent the INR from rising further.
  4. D
    Withhold the dose and document the omission in the medication administration record without taking further action.

Answer

The PN should withhold the scheduled dose of warfarin and immediately notify the registered nurse (RN).
The therapeutic range for an International Normalized Ratio (INR) during standard warfarin therapy is generally 2.02.0 to 3.03.0. An INR of 4.54.5 is significantly elevated, meaning the blood is clotting too slowly and the client is at a high risk for spontaneous bleeding. The safest and most appropriate action within the practical nurse's scope of practice is to withhold the scheduled medication to prevent further harm, and immediately report the critical laboratory value to the supervising RN or healthcare provider. This ensures the provider can evaluate the client, adjust future dosages, and potentially prescribe an antidote (such as vitamin K) if indicated.

Step-by-Step Solution

1
Evaluate the client's laboratory result against standard therapeutic values.
The client's INR is 4.54.5.
The standard therapeutic range for a client on warfarin therapy for a deep vein thrombosis is 2.02.0 to 3.03.0. An INR of 4.54.5 is critically elevated.
2
Determine the physiological risk associated with the laboratory finding.
The client is at a high risk for bleeding.
A supratherapeutic INR indicates that the blood is clotting too slowly, meaning any further administration of an anticoagulant like warfarin could cause severe or life-threatening hemorrhage.
3
Select the appropriate nursing intervention based on the practical nurse (PN) scope of practice.
The medication must be withheld and the RN must be notified.
The PN is responsible for recognizing abnormal findings, ensuring immediate client safety by holding the dangerous medication, and escalating the critical information to the supervising RN or provider for further medical orders.

Key Concept

Pharmacological Therapies: Anticoagulant Monitoring and PN Scope of Practice
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Topics

Pharmacological Therapies

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